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Activity and Exercise Chapter Ra'eda Almashaqba 44 1 Activity and Exercise refers to the persons rotten of exercise, activity , leisure, and recreation Include: 1. Activity of daily living 2. The type, quality, and quantity Of exercise Mobility the ability to move freely, easily, rhythmaticly and purposefully in the environment. Ra'eda Almashaqba 2 Normal movement and stability are the result of An intact musculoskeletal system. An intact nervous system. An intact inner ear structure responsible for equilibrium. Ra'eda Almashaqba 3 Four Basic Elements of Normal Movement Body alignment (posture) Joint mobility Balance Coordinated movement Ra'eda Almashaqba 4 Body Alignment/Posture Brings body parts into position that promotes optimal balance and body function Person maintains balance as long as line of gravity passes through center of gravity and base of support Ra'eda Almashaqba 5 Joint Mobility ROM is maximum movement possible for joint ROM varies and determined by: Genetic makeup Developmental patterns Presence or absence of disease Physical activity Ra'eda Almashaqba 6 Balance Smooth, purposeful movement Result of proper functioning of: Cerebral cortex Cerebellum Initiates voluntary movement Coordinates motor activity Basal ganglia Maintains posture Ra'eda Almashaqba 7 Coordinated Movement Complex mechanisms Proprioception Awareness of posture, movement, changes in equilibrium Knowledge of position, weight, resistance of objects in relation to body Ra'eda Almashaqba 8 Physical activity: body movement produced by musculoskeletal that required energy and produce health benefits. Exercise: type of physical activity defined by planned, structured and repetitive body movement done to improve or maintain body movement. Activity tolerance: type and amount of exercise individual is able to perform without experiencing adverse effect. Ra'eda Almashaqba 9 Type of exercise isotonic(dynamic exercise). Isometric (state or setting) exercise. isokinatic exercise muscle contraction against resistance. Ra'eda Almashaqba 10 Isotonic (Dynamic) Exercise Muscle shortens to produce muscle contraction and active movement Increase muscle tone, mass, and strength Maintain joint flexibility and circulation HR and CO quicken increase running, walking, swimming, activity of daily living , range of motion. Ra'eda Almashaqba 11 Isometric (Static or Setting) Exercise Muscle contraction without moving the joint (muscle length does not change) Involve exerting pressure against a solid object Produce a mild increase in HR and CO No apparent increase in blood flow to other parts of the body Ra'eda Almashaqba 12 Isokinetic (Resistive) Exercise Muscle contraction or tension against resistance Can either be isotonic or isometric Person moves (isotonic) or tenses (isometric) against resistance An increase in blood pressure and blood flow to muscles occurs Ra'eda Almashaqba 13 Exercise according to the source of energy Aerobic. Anaerobic. Ra'eda Almashaqba 14 Aerobic Exercise Activity during which the amount of oxygen taken in the body is greater than that used to perform the activity Improve cardiovascular conditioning and physical fitness use large muscle group Performed continually e.g walking, dancing …. Ra'eda Almashaqba 15 Anaerobic Exercise Activity in which the muscles cannot draw enough oxygen from the bloodstream Anaerobic pathways are used to provide additional energy for a short time Ra'eda Almashaqba 16 Effect on Musculoskeletal System Exercise Immobility Maintain size, shape, tone, and strength of muscles (including the heart muscle) Nourish joints Increase joint flexibility, stability, and ROM Maintain bone density and strength Ra'eda Almashaqba Disuse osteoporosis Disuse atrophy Contractures Stiffness and pain in the joints 17 Effects on the Cardiovascular System Exercise Immobility Increases HR, strength of contraction, and blood supply to the heart and muscles Mediates harmful effects of stress Ra'eda Almashaqba Diminished cardiac reserve Increased use of the Valsalva maneuver Orthostatic hypotension Venous vasodilation and stasis Dependent edema Thrombus formation 18 Leg Veins Inactive Person Active Person Ra'eda Almashaqba 19 Effect on the Respiratory System Exercise Immobility Increase ventilation and oxygen intake improving gas exchange Prevents pooling of secretions in the bronchi and bronchioles Ra'eda Almashaqba Decreased respiratory movement Pooling of respiratory secretions Atelectasis Hypostatic pneumonia 20 Pooling of Secretions: Immobile Person Ra'eda Almashaqba 21 Effects on the Metabolic/Endocrine System Exercise Immobility Elevates the metabolic rate Decreases serum triglycerides and cholesterol Stabilizes blood sugar and make cells more responsive to insulin Ra'eda Almashaqba Decreased metabolic rate Negative nitrogen balance Anorexia Negative calcium balance 22 Effects on the GI System Exercise Immobility Improves the appetite Increases GI tract tone Facilitates peristalsis Ra'eda Almashaqba Constipation 23 Effect on the Urinary System Exercise Immobility Promotes blood flow to the kidneys causing body wastes to be excreted more effectively Prevents stasis (stagnation) of urine in the bladder Ra'eda Almashaqba Urinary stasis Renal calculi Urinary retention Urinary infection 24 Pooling of Urine Ra'eda Almashaqba 25 Effect on the Immune System Exercise Pumps lymph fluid from tissues into lymph capillaries and vessels Increases circulation through lymph nodes Strenuous exercise may reduce immune function Leaving window of opportunity for infection during recovery phase Ra'eda Almashaqba 26 Effect on the Psychoneurologic System Exercise Immobility Elevates mood Relieves stress and anxiety Improves quality of sleep for most individuals Ra'eda Almashaqba Decline in mood elevating substances Perception of time intervals deteriorates Problem-solving and decision-making abilities may deteriorate Loss of control over events can cause anxiety 27 Effect on Cognitive Function Exercise Positive effects on decision-making and problem solving processes, planning, and paying attention Induces cells in the brain to strengthen and build neuronal connections Ra'eda Almashaqba 28 Other Effects of Exercise and Immobility Evidence that certain types of exercise increase spiritual health Immobility causes reduced skin turgor and skin breakdown Ra'eda Almashaqba 29 Factors Affecting Body Alignment, Mobility, and DAL Growth and development Nutrition, personal values and attitudes External factors i.e., Temperature, humidity, availability of recreational facilities, safety of the neighborhood Prescribed limitations i.e., Casts, braces, traction, activity restrictions including bed rest Ra'eda Almashaqba 30 Assessment of Activity and Exercise Nursing History Physical Examination: Body alignment Gait Appearance and movement of joints Capabilities and limitations for movement Muscle mass and strength Activity tolerance Problems related to immobility Ra'eda Almashaqba 31 NANDA Nursing Diagnoses For activity and exercise problems Activity Intolerance Risk for Activity Intolerance Impaired Physical Mobility Sedentary Lifestyle Risk for Disuse Syndrome Ra'eda Almashaqba 32 NANDA Nursing Diagnoses The mobility problem becomes the etiology: Fear (of falling) Ineffective Coping Low Self-Esteem Powerlessness Risk for Falls Self-Care Deficit Ra'eda Almashaqba 33 NANDA Nursing Diagnoses Prolonged immobility: Ineffective Airway Clearance Risk for Infection Risk for Injury Risk for Disturbed Sleep Pattern Risk for Situational Low Self-Esteem Ra'eda Almashaqba 34 Examples of Desired Outcomes (NOC Labels) Activity tolerance Body positioning Bowel elimination Fall prevention behavior Immobility consequences both physiological and psychocognitive Joint movement Mobility Respiratory status Ventilation and gas exchange Self-care Sleep Stress level Weight control Ra'eda Almashaqba 35 Overall Goals for Problems Related to Mobility or Activity Increased tolerance for physical activity Restored or improved capability to ambulate and/or participate in ADLs Absence of injury from falling or improper use of body mechanics Enhanced physical fitness Absence of any complications associated with immobility Improved social, emotional, and intellectual well-being Ra'eda Almashaqba 36 Safe Practice for Positioning, Moving, Lifting, Ambulating Clients Correct body mechanics required for nurse to prevent injury Correct body alignment for the client also so that undue stress is not placed on the musculoskeletal system Ra'eda Almashaqba 37 General Guidelines for Moving and Lifting Before moving, assess If indicated, use pain relief modalities Prepare any needed assistive devices Plan around encumbrances Be alert to the effects of any medications Obtain required assistance Explain the procedure to the client Ra'eda Almashaqba 38 General Guidelines for Transferring a Client Plan what to do and how to do it Obtain essential equipment before starting Remove obstacles Explain transfer to client and assistive personnel Support or hold client rather than equipment Explain what client should do Make written plan, including client’s tolerance Ra'eda Almashaqba 39 General Guidelines for Ambulating Assess the amount of assistance the client will require Assess for signs and symptoms of orthostatic hypotension Prepare client for ambulation Apply transfer or walking belt Physically support client Obtain assistance to follow with wheelchair or assist with physical support Teach client to correctly use mechanical aids Ra'eda Almashaqba 40 Ra'eda Almashaqba 41
